Life & Health Insurance

You should consider term life insurance if:

You need life insurance for a specific period of time. Term life insurance enables you to match the length of the term policy to the length of the need. For example, if you have young children and want to ensure that there will be funds to pay for their college education, you might buy 20-year term life insurance. Or if you want the insurance to repay a debt that will be paid off in a specified time period, buy a term policy for that period.

You need a large amount of life insurance, but have a limited budget. In general, this type of insurance pays only if you die during the term of the policy, so the rate per thousand of death benefit is lower than for permanent forms of life insurance. If you are still alive at the end of the term, coverage stops unless the policy is renewed. Unlike permanent insurance, you will not build equity in the form of cash savings.

If you think your financial needs may change, you may also want to look into convertible term policies. These allow you to convert to permanent insurance without a medical examination in exchange for higher premiums.

Keep in mind that premiums are lowest when you are young and increase upon renewal as you age. Some term insurance policies can be renewed when the policy ends, but the premium will generally increase. Some policies require a medical examination at renewal to qualify for the lowest rates.

You should consider permanent life insurance if:

You need life insurance for as long as you live. A permanent policy pays a death benefit whether you die tomorrow or live to be 100.

You want to accumulate a savings element that will grow on a tax-deferred basis and could be a source of borrowed funds for a variety of purposes. The savings element can be used to pay premiums to keep the life insurance in force if you can’t pay them otherwise, or it can be used for any other purpose you choose. You can borrow these funds even if your credit is shaky. The death benefit is collateral for the loan, and if you die before it’s repaid, the insurance company collects what is due the company before determining what goes to your beneficiary.

Keep in mind that premiums for permanent policies are generally higher than for term insurance. However, the premium in a permanent policy remains the same no matter how old you are, while term can go up substantially every time you renew it.

In most cases, if you have no dependents and have enough money to pay your final expenses, you don’t need any life insurance.

If you have dependents, buy enough life insurance so that, when combined with other sources of income, it will replace the income you now generate for them, plus enough to offset any additional expenses they will incur to replace services you provide (for a simple example, if you do your own taxes, the survivors might have to hire a professional tax preparer). Also, your family might need extra money to make some changes after you die. For example, they may want to relocate, or your spouse may need to go back to school to be in a better position to help support the family.

You should also plan to replace “hidden income” that would be lost at death. Hidden income is income that you receive through your employment but that isn’t part of your gross wages. It includes things like your employer’s subsidy of your health insurance premium, the matching contribution to your 401(k) plan, and many other “perks,” large and small. This is an often-overlooked insurance need: the cost of replacing just your health insurance and retirement contributions could be the equivalent of $2,000 per month or more.

Of course, you should also plan for expenses that arise at death. These include the funeral costs, taxes and administrative costs associated with “winding up” an estate and passing property to heirs. At a minimum, plan for $15,000.

A multiple of salary?

Many pundits recommend buying life insurance equal to a multiple of your salary. For example, one financial advice columnist recommends buying insurance equal to 20 times your salary before taxes. She chose 20 because, if the benefit is invested in bonds that pay 5 percent interest, it would produce an amount equal to your salary at death, so the survivors could live off the interest and wouldn’t have to “invade” the principal.

However, this simplistic formula implicitly assumes no inflation and assumes that one could assemble a bond portfolio that, after expenses, would provide a 5 percent interest stream every year. But assuming inflation is 3 percent per year, the purchasing power of a gross income of $50,000 would drop to about $38,300 in the 10th year. To avoid this income drop-off, the survivors would have to “invade” the principal each year. And if they did, they would run out of money in the 16th year.

What’s left out?

The surviving spouse will have no income from Social Security from age 53 until 60 unless the deceased buys additional life insurance to cover this period. It could be assumed that the surviving spouse will obtain a job at or before this time, but she could also become disabled or otherwise unable to work. If life insurance were bought for this period, the additional amount of insurance needed would be about $335,000.

Some people like to plan to use life insurance to pay off the home mortgage at the primary income earner’s death, so that the survivors are less likely to face the threat of losing their home. If life insurance were bought for this goal, the additional amount of insurance needed is the amount of the unpaid balance on the mortgage.

Some people like to provide money to pay to send their children to college out of their life insurance. We may assume that each child will attend a public college for four years and will need $15,000 per year. However, college costs have been rising faster than inflation for many decades, and this trend is unlikely to slow down. If life insurance were bought for this goal, the additional amount of insurance needed would be about $200,000.

In the example, no money is planned for the surviving spouse’s retirement, except for what the spouse would be entitled to receive from Social Security (about $1,200 per month). It could be assumed that the surviving spouse will obtain a job and will either participate in an employer’s retirement plan or save with an IRA, but she could also become disabled or otherwise unable to work. If life insurance were bought to provide the equivalent of $4000 per month starting at age 60 until 65 and $3,000 per month from 65 on (because at 65 Medicare will make carrying private health insurance unnecessary), the additional amount of insurance needed would be about $465,000.

The main reason for buying life insurance on anyone’s life is to replace income “lost” or pay for expenses caused by the death of the insured person. If your child dies, there is no lost income, but there will be funeral, burial and related expenses that could run to thousands of dollars, which might cause a financial hardship to the parents of the deceased child.

Another reason for buying life insurance on a child’s life is to guard against the possibility that, when the child is older, he or she might not be able to buy life insurance because of intervening illness or other circumstance.

Still another reason for buying life insurance on a child’s life is part of a program to teach the child financial responsibility. Typically the insurance is whole life insurance, ownership of which is transferred to the child when he or she turns 21.

Most insurance advisors recommend that families spend their insurance budget to buy life and disability income insurance on the parents first, before considering insurance on children’s lives. Death of a parent, particularly an income-earner, could have financial consequences that are devastating compared to the financial effects from a child’s death.

There are essentially two types of health insurance plans: indemnity plans (fee-for services) or managed care plans. The differences include the choice of providers, out-of-pocket costs for covered services and how bills are paid. There is no one “best” plan for everyone. Some plans are better than others for your or your family’s health care needs, but no one plan will pay for all the costs associated with your medical care.

A. Indemnity Plans
Indemnity Health Plans allow you to choose your health care providers. You can go to any doctor, hospital or other provider for a set monthly premium. The plan reimburses you or your health care provider on the basis of services rendered. You may be required to meet a deductible and pay a percentage of each bill. However, there is also often an annual limit on out-of-pocket expenses, so that once an individual or family reaches the limit, the insurance covers the remaining eligible medical expenses in full. Indemnity plans sometimes impose restrictions on covered services and may require prior authorization for hospital care or other expensive services.

Health Savings Accounts (HSA) are a recent alternative to traditional health insurance plans. HSAs are basically a savings product designed to offer individuals a different way to pay for their health care. HSAs enable you to pay for current health expenses and save for future qualified medical and retiree health expenses on a tax-free basis. Instead of paying a premium, you establish a tax-free savings account that covers your out-of-pocket medical expenses. This means that you own and control the money in your HSA. You make all decisions about how to spend the money without relying on a third party or a health insurer. You also decide what types of investments to make with the money in the account in order to make it grow. However, if you sign up for an HSA, you are generally required to buy a High Deductible Health Plan as well.

High-Deductible Health Plans (HDHP) are sometimes referred to as catastrophic health insurance coverage. An HDHP is an inexpensive health insurance plan that kicks in only after a high deductible is met of at least $1,000 for an individual or $2,000 for a family.

B. Managed Care Options
Health Maintenance Organizations (HMOs) offer access to an extensive network of participating physicians, hospitals and other health care professionals and facilities. You choose a primary care doctor from a list provided by the HMO and this doctor coordinates your health care. You must contact your primary care doctor to be referred to a specialist. Generally, you pay fewer out-of-pocket expenses with an HMO, but you are often charged a fee or co-payment for services such as doctor visits or prescriptions.

Point-of-Service (POS) plans are an indemnity-type option in which the primary care doctors in the POS plan usually make referrals to other providers within the plan. If a doctor makes a referral out of the plan, the plan pays all or most of the bill. However, if you refer yourself to an outside provider, the service is covered by the plan, but you will be required to pay co-insurance.

Preferred Provider Organizations (PPO) charge on a fee-for-service basis. The participating doctors, hospitals and health care providers are paid by the insurer on a negotiated, discounted fee schedule. Costs are lower if you use in-network healthcare services, but you have the option of going out-of-network. If you choose an out-of-network provider, you are generally required to pay the difference between what the provider charges and what the plan pays.

Whether your employer gives you a choice of plans or you need to purchase your own coverage, it is crucial that you understand your health insurance choices and pick the insurance that is best for you and your family.

Here are some questions you should ask yourself when choosing a health insurance plan:

How affordable is the cost of care?

What is the monthly premium I will have to pay?
Should I try to insure most of my medical expenses or just the large ones?
What deductibles will I have to pay out-of-pocket before insurance starts to reimburse me?
After I have met my deductible, what percentage of my medical expenses are reimbursed?
How much less am I reimbursed if I use doctors outside the insurance company’s network?

Does the insurance plan cover the services I am likely to use?

Are the doctors, hospitals, laboratories and other medical providers that I use in the insurance company’s network?
If I want to use a doctor outside the network, will the plan permit it?
How easily can I change primary-care physicians if I want to?
Do I need to get permission before I see a medical specialist?
What are the procedures for getting care and being reimbursed in an emergency situation, both at home or out of town?
If I have a preexisting medical condition, will the plan cover it?
If I have a chronic condition such as asthma, cancer, AIDS or alcoholism, how will the plan treat it?
Are the prescription medicines that I use covered by the plan?
Does the plan reimburse alternative medical therapies such as acupuncture or chiropractic treatment?
Does the plan cover the costs of delivering a baby?

Co-payments or Co-insurance

Co-insurance or a co-pay is a percentage of each claim above the deductible paid by the insured. For a 20 percent health insurance co-insurance clause, for example, you would pay the deductible plus 20 percent of the covered losses. After the insurer pays 80 percent of the losses up to a specified ceiling, the insurer will start paying 100 percent of the losses.

Deductible

A deductible is the amount of loss paid by you before the insurance kicks in. Either a specified dollar amount, a percentage of the claim amount, or a specific amount of time must elapse before benefits are paid. The bigger the deductible, the lower the premium charged for the same coverage.

HIPAA (Health Insurance Portability and Accountability Act)

HIPAA established national standards for the portability of insurance and set security standards for electronic health care information. HIPAA regulates the availability and breadth of group and individual health insurance plans, amending both the Employee Retirement Income Security Act and the Public Health Service Act. HIPAA prohibits any group health plan from creating eligibility rules or assessing premiums for individuals in the plan based on health status, medical history, genetic information or disability. It does not apply to private individual insurance. It also limits restrictions that a group health plan can place on benefits for preexisting conditions. HIPAA also includes rules aimed at increasing the efficiency of the health care system by creating standards for the use and dissemination of health care information. The final rule adopting HIPAA standards for security was published in the Federal Register on February 20, 2003. This rule specifies a series of administrative, technical, and physical security procedures for covered entities to use to assure the confidentiality of electronic protected health information.

In-Network/Out-of-Network

Managed care plans have agreements with certain doctors, hospitals, and health care providers (in-network) to provide a range of services to plan members at reduced cost. Generally, you have less paperwork and lower out-of-pocket costs if you stay in-network. However, you give up some flexibility. If you decide to go out-of-network – i.e., use a health care provider that is not part of the managed care plan – you will generally pay more for your health care services because you are required to pay the difference between in-network and out-of-network costs.

Preexisting Condition

A preexisting condition is a medical condition diagnosed before joining a new plan. Many insurance plans will not cover preexisting conditions and some will cover them only after a waiting period. However, in 1997, Congress passed the Health Insurance Portability and Accountability Act (HIPPA), which mandates that preexisting conditions be covered without a waiting period when an individual who has been insured during the previous 12 months joins a new group plan.

Preexisting Condition

A preexisting condition is a medical condition diagnosed before joining a new plan. Many insurance plans will not cover preexisting conditions and some will cover them only after a waiting period. However, in 1997, Congress passed the Health Insurance Portability and Accountability Act (HIPPA), which mandates that preexisting conditions be covered without a waiting period when an individual who has been insured during the previous 12 months joins a new group plan.